Parents who generally have their children use booster seats in the car are not consistent in their use of booster seats when carpooling, researchers found.

Action Points

Explain that parents who generally have their children use booster seats in the car are not consistent in their use of booster seats when carpooling.

Point out that children were more likely to use a safety seat if they were younger or lived in a state where booster seat use was mandated by law.

Parents who generally have their children use booster seats in the car are not consistent in their use of booster seats when carpooling, researchers found.

Among parents who reported carpooling and using child safety seats, only 79% said they would always ask another driver to use a booster seat for their child and only 55% said they always have their child use a booster seat when friends without a seat were in the car, according to Michelle Macy, MD, of the University of Michigan in Ann Arbor, and colleagues.

"These findings suggest that social norms and self-efficacy for booster seat use may be influential in carpooling situations," they wrote in the February issue of Pediatrics.

They said that clinicians have a role to play in expressing the importance of using restraints that are appropriate for a child's size every time they are in the car, noting that no state mandates booster seat use based on child size.

"Because parents look to healthcare providers for information about keeping their child safe, clinical encounters are an important opportunity to emphasize the fact that booster seats improve seat belt fit for children beyond the age limits in many state laws," they wrote.

In an updated policy statement on child passenger safety released last year, the American Academy of Pediatrics reduced the emphasis on age, recommending the use of a booster seat from the time children outgrow their forward-facing car seat until they reach 4 feet 9 inches tall, around ages 8 to 12. That was consistent with new guidance from the National Highway Traffic Safety Administration released at the same time.

Studies have shown, however, that booster seat use declines from ages 4 to 8, with use even worse when carpooling.

To explore the use of booster seats when carpooling, Macy and colleagues examined data from the C.S. Mott Children's Hospital National Poll on Children's Health, which, in addition to other items, included 12 questions about child restraints.

The analysis represented 681 parents of children, ages 4 to 8.

Because of the difficulty in distinguishing between car seats and booster seats, responses were combined into child safety seats. Overall, 76% of the parents reported using one. Children were more likely to use a safety seat if they were younger or lived in a state where booster seat use was mandated by law.

The remaining one-quarter of parents said that their children used seat belts but not safety seats. Of these respondents, about three-quarters (74%) were in accordance with their state's law.

Regardless of the type of restraint used for their children, most parents (64%) reported that they participated in carpooling. Booster seats were not uniformly used when the parents were driving other children.

"Further study is needed to determine the extent to which peer interactions between parents and between children contribute to inconsistent use of booster seats when carpooling," the authors wrote.

They acknowledged some limitations of the study, including the use of self-reported information on parental behaviors; the inability to distinguish between different types of safety seats; and the possible influence of social desirability and participation biases.

The study was conducted as part of the C.S. Mott Children's Hospital National Poll on Children's Health, sponsored by the Department of Pediatrics and Communicable Diseases at the University of Michigan and the University of Michigan Health System. The study was funded by a grant from the Michigan Center for Advancing Safe Transportation Throughout the Lifespan.

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